Depression is predicted to be the second largest contributor to the global burden of disease by the year 2020. By 2030, depression will be the #1 contributor to the global burden of chronic disease in high-income countries.

There is a greater than 16% lifetime risk of major depressive disorder (MDD). Persons living below the poverty level are nearly 2½ times more likely to have depression. 43% of persons with severe depressive symptoms report serious difficulties in work, home, and social activities.

There are no laboratory tests for MDD and diagnosis depends on a trained clinician asking people about their symptoms. The estimated prevalence of depressive disorders is 13-22% in primary care clinics but is only recognized in half of those patients.

Through the lens of DSM-V, the many faces of depression include:

Major Depressive Disorder

Persistent Depressive Disorder

Premenstrual Dysphoric Disorder

Disruptive Mood Dysregulation Disorder

Substance/medication induced Depressive Disorder

Other Specified Depressive Disorder

Unspecified Depressive Disorder

Let’s examine the modern medical “miracle.” According to the STAR*D Trial, only 25% patients taking antidepressants long-term experience remission. By comparison, the response to placebo was 20%. Ouch!!! The bottom line is that these medications appear to have a relatively small effect in patients broadly classified as having depression.

In a way, depression is probably a normal response to the comonplace stress, isolation, malnourished, sedentary and menial nature of our modern life “style. Attempts to “fix” depression with medications are not just ineffective, they actually silence the human spirit’s healthy and normal response to what the Hopi Indians named “Koyaanisqatsi” meaning crazy life, a life out of balance, or a way of being that by it’s very nature… cries for another.

It’s hard to notice how sedentary our lives are. Exercise is the NUMBER ONE treatment for depression. Exercise induces the formation of stem cells, so in a way exercise juvenileses you by at least temporarily pushing the “reset button.” Both aerobic (e.g. running, swimming) and anaerobic (e.g. weights or resistance training) exercises are effective in decreasing depression symptoms and enhancing positive mood in patients. Several studies of exercise, yoga and meditation have demonstrated therapeutic effectiveness comparable with conventional depression and anxiety treatments.

Practically speaking, 30 minutes/day of moderate to high intensity exercise five days a week is often cited in the literature as ideal. Realistically, we can and should asses the current level of fitness and start low and build up to individually “ideal” doses.

Just as important as movement as a therapy for depression, is adequate rest. 7.5-9 hours of good quality sleep is essential.

My front-line therapy for anxiety is L-Theanine, a non-essential amino acid with a variety of health benefits. It is abundant in green tea. It is often helpful in what I call “anxious-depression” because it increases GABA and glycine levels in the brain. GABA and glycine are inhibitory neurotransmitters that work to offset overactive excitatory neurotransmitters. Theanine promotes a state of relaxation and calm and thereby, reduces the symptoms of anxiety and depression. 100-300mg of chewable L-Theanine can be VERY effective for depression if the underlying problem is anxiety.

Oxidative stress is a form of rust, and it happens in our bodies too. Although it not a pretty picture, our brains are basically big bags of fat waiting to oxidize (go rancid). Given the prevalence of fried foods, fake fats, and corn-fed animal products, its no wonder that even though it is “standard” our the standard American diet is fueling oxidative stress and significantly driving the modern epidemic of depression. Consuming healthy fats like DHA supplements, phosphatidyl choline, and uncooked vegetable oils amounts to an “oil change” for your brain, and can be really helpful for cognitive function and resilience.

We’ve been hearing a lot about the value of probiotics to reduce inflammation and promote more ideal digestion and assimilation. For mental health, the “gut-feeling” adage is actually quite real. There are far more neurotransmitters made in our guts than our brains. Having a healthy gut flora ecosystem can not be underestimated, and new research is coming out that taking probiotics can actually have a profound antidepressant and anxiolytic effects.

There’s no better way to change your gut flora than to change your diet, and for this and many other reasons, the healthiest diet is one similar to what we would have been eating BEFORE agriculture: vegetables, berries, fruit, eggs, wild fish, and free-range meats. Simply put, this means taking out dairy, grains, processed foods, and refined sugars. I often tell my patients to completely avoid the middle aisles in grocery stores–there’s nothing you need there. Not just for depression, this kind of cleaned up, whole food ancient diet can address the underlying causes of myriad conditions and symptoms. Avoiding sugar, gluten (from wheat, barley and rye) and dairy is often considered the baseline functional treatment for inflamation, dysbiosis, and autoimmune disease

Genetic differences in the methylation cycle are getting a lot of press these days. It’s true that variations in the 667 and 1298 position on the MTHFR enzyme are quite common. Over 40% of the population has at least one of the eight possible combinations of variants in just these two positions. The prevalence of these variants in depressed people is nearly double. Anxiety, bipolar and schizophrenia risk is also significantly increased in people with major MTHFR variations. If you also have a genetic variant (SNP) of the MTHFR or MTRR gene, then methylation support (methyl-folate, methyl-B12, B6-P5P) may help because these activated vitamins leap-frog over the genetic variants, and so taking these can be profoundly helpful in some cases of physiologic depression and anxiety.

Beyond exercise, sleep, a clean diet, healthy fats, other things we can do to support optimal mood include mindful breathing, mindfulness meditation, adopting a pet, and cultivating gratitude and acceptance.

Other supplements that can help depressive states include: 5HTP, SAMe, L-Tyrosine, DHEA, and adrenal support. DHEA is an androgen and is the a precursor for Testosterone. If DHEA levels or testosterone levels are low (in both men and women) this alone could be the cause of depression.

The most common family of antidepressant drugs are in the selective serotonin reuptake inhibitor (SSRI) class of drugs: Prozac, Paxil, Zoloft, Celexa. All of the SSRIs work by recycling the serotonin, thereby increasing contentment, ease, and general happiness. Natural ways to support serotonin levels are to take 100mg 5HTP, and Vitamin B6. These can be very effective and usually have no side effects. Can you get too much of the serotonin effect? Absolutely. It’s all about balance. For these reasons, never take tryptophan or 5-HTP support while taking an SSRI unless you are under the care of a skilled practitioner.

Some depressive states are more conected to dopamine production than serotonin. Dopamine production can be naturally supported by 1000 mg L-Tyrosine 2x/day, and SAM-e 400 mg 2x/day.

I do use these to help some patients get traction, but they are not substitutes for the fundamental modifiable lifestyle factors: Exercise, Sleep, a clean diet and stress reduction. These key lifestyle interventions are simple, but they are often not easy.

If you or someone you know who is facing symptoms of the modern epidemic of depression or anxiety, I urge you to consider partnering with a knowledgeable ND, functional medicine practitioner, or certified life coach to make the changes that address the root causes and support optimal mental health.